Provider Demographics
NPI:1891195566
Name:CASTELLANOS-GRAHAM, SOUL (LMT)
Entity type:Individual
Prefix:MRS
First Name:SOUL
Middle Name:
Last Name:CASTELLANOS-GRAHAM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 ELKTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5424
Mailing Address - Country:US
Mailing Address - Phone:443-553-5989
Mailing Address - Fax:
Practice Address - Street 1:602 ELKTON BLVD
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5424
Practice Address - Country:US
Practice Address - Phone:443-553-5989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist